Safety And Efficacy Of Losartan (50 Mg) In Post Dialysis Euvolemic Hypertensive Patients: A Single-Blind Randomized Control Trial

Patients with End Stage Renal Disease (ESRD) require lifelong fluid replacement therapy or renal transplant. Almost 60-90 % haemodialysis patients are hypertensive. Studies aimed at elucidating the pathophysiology of hypertension among haemodialysis patients concluded that 90% cases resulted from sodium and volume overload (volume-dependent), while the majority of the remaining cases have elevated renin activity (renin dependent), leading to renin dependent high blood pressure. Since there is a constant volume variation during dialysis session, there is a strong possibility for activation of Renin Angiotensin Aldosterone System (RAAS) during dialysis that causes high blood pressure even if they are post dialysis euvolemic

Evaluation Of Doctor’s Knowledge, Attitude, Adherence To Clinical Practice Guideline (Gina 2011) Recommendations And Cost Associated With Asthma Treatment

The existing literature suggests that doctors’ divergence from GINA guidelines is one of the major contributing factor for poor asthma control. The present study includes 27 doctors from the emergency department and 6 doctors from the respiratory department in study that was conducted at Hospital Pulau Pinang (HPP). Its aim was to evaluate doctors’ knowledge, attitude towards asthma clinical practice guideline (CPG), factors affecting asthma management, practices on GINA 2011 guideline and direct cost associated with asthma treatment at HPP. literatur yang sedia ada mencadangkan bahawa ketidakpatuhan doktor terhadap garis panduan GINA ini adalah salah satu faktor utama yang menyumbang kepada kawalan asma yang kurang memuaskan. Kajian ini melibatkan 27 doktor dari Jabatan Kecemasan dan 6 doktor dari Jabatan Respiratori yang terlibat dalam satu kajian yang telah dijalankan di Hospital Pulau Pinang (HPP). Matlamatnya adalah untuk menilai pengetahuan doktor, sikap terhadap garis panduan amalan klinikal asma (CPG), faktor yang mempengaruhi pengurusan asma, ketetapan doktor terhadap garis panduan GINA 2011 dan kos langsung yang berkaitan dengan rawatan asma di HPP

Acute Ischemic Stroke and Acute on Chronic Kidney Disease

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating conditio

Commentary: Outbreak of Chikungunya in Pakistan

Rauf et al. in their recent correspondence in “Lancet Infectious Diseases” reported the first chikungunya outbreak in Karachi, Pakistan with 30,000 suspected and 4,000 confirmed cases (1). However, these estimates have been denied in a subsequent report by the National Institute of Health (NIH) indicating 818 suspected and 82 laboratory-confirmed cases of chikungunya (2). Rauf and colleagues have highlighted warm climate and wretched sanitary conditions as contributing factors of current outbreak and urge national and international health-organizations to address these momentous issues (1). We agree that climatic features and sanitation issues potentially lead to vector proliferation and the importance of these concerns cannot be disregarded. However, we felt inclined to share our point of view about the recent outbreak of chikungunya in Pakistan. We believe that there are some more important factors that should be considered as causes of this outbreak and must be addressed by the Government of Pakistan in haste to quell the further disease spillover. One of these factors is unchecked cross-border movements between Pakistan and India

Acute Ischemic Stroke and Acute on Chronic Kidney Disease

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating conditio

Awareness and knowledge of Chikungunya infection following its outbreak in Pakistan among health care students and professionals: a nationwide survey

Background The World Health Organization (WHO) declares Chikungunya (CHIK) infection to be endemic in South Asia. Despite its first outbreak in Pakistan, no documented evidence exists which reveals the knowledge or awareness of healthcare students and workers (HCSW) regarding CHIK, its spread, symptoms, treatment and prevention. Since CHIK is an emergent infection in Pakistan, poor disease knowledge may result in a significant delay in diagnosis and treatment. The current study was aimed to evaluate the awareness and knowledge of CHIK among HCSW. Methods A cross-sectional study was conducted among HCSW from teaching institutes and hospitals in seven provinces of Pakistan. We collected information on socio-demographic characteristics of the participants and their knowledge by using a 30-item questionnaire. The cumulative knowledge score (CKS) was calculated by correct answers with maximum score of 22. The relationship between demographics and knowledge score was evaluated by using appropriate statistical methods. Results There were 563 respondents; mean age 25.2 ± 5.9 years with female preponderance (62.5%). Of these, 319 (56.7%) were aware of CHIK infection before administering the survey. The average knowledge score was 12.8 ± 4.1 (% knowledge score: 58.2%). Only 31% respondents had good disease knowledge while others had fair (36.4%) and poor (32.6%) knowledge. Out of five knowledge domains, domain III (vector, disease spread and transmission) and V (prevention and treatment) scored lowest among all i.e. percent score 44.5% and 54.1%, respectively. We found that socio-demographic characteristics had no influence on knowledge score of the study participants. Conclusion Approximately one-half of participants were not aware of CHIK infection and those who were aware had insufficient disease knowledge. Findings of the current study underscore the dire need of educational interventions not only for health care workers but also for students, irrespective to the discipline of study

Relationship between the use of drugs and changes in body weight among patients: A systematic review and meta-analysis

Purpose: To investigate the impact of drugs on the body weight of patients.Methods: All the randomized controlled trials that evaluated the impact of medications on the body weight of patients were searched in various databases. Studies quantifying the impact of drugs on body weight when compared to placebo or any other treatment were considered for this review. Moreover, the quantitative synthesis of evidence was also performed by generating the forest plot.Results: A total of 20 studies involving 18,547 participants were included in the current review. Weight gains ranging from 0.5 to 2.6 kg were associated with the use of pioglitazone, espindolol, brexpiprazole, glimepiride and ezogabine while weight loss ranging from 1.1 to 12 kg was linked with the use of betahistine, naltrexone, bupropion, liraglutide, phentermine, topiramate, orlistat, zonisamide, duloxetine, semaglutide, metformin and linagliptin. The quantitative synthesis suggested that drugs can significantly reduce body weight by -0.53 kg (CI 95 % -1.01, -0.04, p < 0.04) when compared to standard treatment.Conclusion: The findings of this review suggest substantial association of drugs and weight change during pharmacotherapy. Pioglitzone, brexpiprazole, espindolol, ezogabine and glimepiride cause weight gain while naltrexone, bupropion, betahistine, topiramate, phentermine, zonisamide, semaglutide, linagliptin, liraglutide, orlistat, duloxetine and metformin were associated with weight loss. Drug-induced changes in body weight might cause serious consequences and should be addressed before initiating treatment

Risk factors associated with nosocomial infections among end stage renal disease patients undergoing hemodialysis: A systematic review.

BackgroundProfound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections.Aims and objectiveThe aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis.MethodsA systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099).ResultsInitially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients.ConclusionThe results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures

Acute Ischemic Stroke and Acute on Chronic Kidney Disease

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition. Keywords: ischemic disease; chronic kidney disease; uncontrolled hypertension. | PubMe